Provider Demographics
NPI:1275552879
Name:KEMPTON, CARLY M (AUDIOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:M
Last Name:KEMPTON
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:516 DELAWARE ST
Mailing Address - Street 2:8-100 PWB, MMC 283
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6518
Mailing Address - Fax:612-625-8901
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:8-100 PWB, MMC 283
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-6518
Practice Address - Fax:612-625-8901
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN7920231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN166905200Medicaid